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The Adlerian approach: a practical psychology for family practice.

A systematic approach to understanding the patient's personality and helping him cope with common life problems is found in Adlerian Psychology. It is uniquely appropriate to family practice because it stresses the interpersonal purposes of behavior and symptoms and the influence of family constellation on the development of the individual life-style. By obtaining a small amount of data about the patient's present life situation and his family of origin, the physician can gain a basis for understanding how the patient developed his unique way of acting and reacting to the physical and social stresses of life. Interpretation of two or three early recollections reveals what the patient expects of himself, others, and life. The insight thus gained is used as the basis for a holistic assessment of the problem; a directive, supportive, action-oriented plan for treatment; and an ongoing doctor-patient relationship of mutual respect.

Adolescent

Psychological practice in a pediatric rehabilitation hospital.

Described 127 consecutive referrals to a newly formed psychological consultation service in a pediatric rehabilitation hospital. This setting served children whose needs for comprehensive care and long-term hospitalization could not be met effectively elsewhere in the community. The complex patient population included children with permanent mental and/or physical handicaps who had survived due to advances in medical technology, those with traumatic or congenital brain injury, failure to thrive, feeding problems, apnea, tracheostomy, child abuse, and psychosomatic disorders. A range of psychological services were offered, including specialized assessments and treatment planning for rehabilitation, home and school placement, direct treatment and monitoring of behavioral progress, and consultation with staff. Implications for the practice of pediatric psychology and service delivery to patients in pediatric rehabilitation settings are discussed.

Adolescent

The treatment of emotional disorders in general practice: psychological methods versus medication.

This paper describes three recent trials in which psychological methods were evaluated in the treatment of emotional disorders in general practice. In the first trial, brief counselling by the general practitioner was found to be as effective as anxiolytic medication, was welcomed by patients and did not increase demands on doctors' time. In the second trial (still in progress), in which treatment is aimed at emotional disorders of poor prognosis, problem solving treatment by a psychiatrist is being compared with control treatment by the G.P. The third trial evaluated an anxiety management programme provided by clinical psychologists in health centres; substantial reductions in anxiety occurred rapidly and were maintained at follow-up.

Affective Symptoms

Neuropsychophysiology during relaxation in generalized, universal 'allergic' reactivity to the environment: a comparison study.

Comparisons were made among a group of patients presenting with universal 'allergic' intolerance to environmental chemicals (universal reactor, n = 58), a group of control subjects without psychologic symptoms (control, n = 55) and a group of outpatients from a psychology practice (psychologic, n = 89) on neuropsychophysiological measures during relaxation. The measures were electroencephalographic (EEG) spectral category for frequencies below 15 Hz, EEG beta activity, scalp electromyography (EMG), peripheral temperature (TEMP), and skin resistance level (SRL). The distributions of subjects in each group across eight EEG spectral categories were significantly different, with the distribution for universal reactors the same as that of the psychologic patients (p = 0.22), and both different from the distribution of controls (p less than 0.001). High levels of EEG beta activity were observed in more universal reactors and psychologic patients than in controls (p = 0.04). High levels of EMG scalp activity were observed in a greater number of universal reactors than in subjects in the other two groups (p less than 0.001). The three groups did not differ in TEMP and SRL. Implications of neuropsychophysiologic stress profiling for the diagnosis and treatment of psychosomatic illness are discussed.

Adult

[Practical and psychological problems in invalidation evaluation].

Practical and psychological problems to give opinions of invalid were discussed and the defects of the practice in the neurologic and psychiatric branch of science are shown. The declaration of psychiatric findings is called to special attention.

Disability Evaluation

What have surveys taught us about the teaching and practice of psychological assessment?

In efforts to gather information about training in and the practice of psychological assessment, numerous surveys of practicing psychologists, training program directors, and internship training directors have been conducted. In this article, I briefly review all survey studies about psychological assessment that have appeared in the last 30 years (1960 through early 1990). The major findings of all the surveys are summarized in 14 points, and discussion of several of the points is provided. Of most significance, the surveys collectively attest to (a) the remarkable stability of psychologists' assessment practices over the past 3 decades; (b) the ever-consistent, ever-continuing significance of the assessment role in psychological training and practice; and (c) the resilient, enduring nature of projective techniques in psychodiagnostic assessment.

Curriculum

A positive association between physical health practices and psychological well-being.

The association between psychological well-being (PWB) and health practices (HP) has not been explored. PWB is associated with age, income, education, and physical health. Physical health has been shown to relate to seven HP: sleep, physical exercise, breakfast, snacking, relative body weight, smoking, and alcohol consumption. The purpose of this study was to investigate the relationship between PWB and these seven physical health practices. Data were obtained from a cross-sectional health survey of 6320 persons. PWB was measured as an overall score, with positive feelings and negative feelings as subscores. Each of the three PWB measures was related to favorable health practices. The clinical significance of this relationship remains to be determined. In addition, PWB was noted to improve with age. Although one cannot infer causal relations from cross-sectional data, physical health practices may be important mediators of the mind-body interaction.

Adult

The theory and practice of psychological medicine in the Ayurvedic tradition.

In this paper I attempt to elucidate and render intelligible to a non-Western reader the internal logic and the consistency in both theory and practice of Ayurvedic psychological medicine. In Part 1, I deal with the classical metaphysical base (Samkya philosophy) on which the Ayurvedic concept of mind rests. I also deal with the theory of psychological medicine as stated in ancient Sanskrit texts. In Part II, I deal with the manner in which the classic theory is implemented in contemporary practice in Sri Lanka, while Part III deals with case studies of two patients taking Ayurvedic therapy.

Adolescent

Prolonged intubation vs. tracheotomy: complications, practical and psychological considerations.

The charts of 52 adult patients who underwent tracheotomy (49 after intubation) were reviewed to identify early complications of both endotracheal intubation and tracheotomy. The complication rate of endotracheal intubation was 57%, and of tracheotomy, 14%. None of the complications of tracheotomy was serious. Sixty critical-care nurses were surveyed about their attitudes regarding prolonged endotracheal intubation and tracheotomy. A large majority preferred tracheotomy for patients who require airway support, for several reasons. First, they felt that tracheotomy patients were more comfortable and, therefore, required less sedation and restraint. Second, the patients could communicate more effectively. Third, airway care was simplified. Ninety-two percent of nurses stated that they would prefer a tracheotomy for themselves or a loved one if more than 10 days of ventilatory support were required. We conclude that tracheotomy can be performed safely in this group of patients, and that it offers significant practical and psychological benefits compared to prolonged endotracheal intubation.

Aged